Minimally-invasive LVAD-implantation improves outcome in reoperative cases

Objective: The number of LVADs implanted is constantly increasing and concordantly due to novel technologies the size of VADs is steadily decreasing. These novel miniaturized devices require adapted less invasive implantation strategies.

Due to the increased perioperative risks of LVAD-implantation in reoperative cases a minimally-invasive approach seems to be beneficial. We aimed to investigate if our novel minimal-invasive surgical approach may improve the postoperative outcome in reoperative cases.

Methods: We analysed the data of patients with end-stage cardiac failure who were re-operated with a novel minimally-invasive LVAD-implantation-technique: upper hemisternotomy combined with antero-lateral thoracotomy.

Results: In 15 patients (13 male, 2 female) a novel, minimized approach for LVAD-implantation was used. All patients previously underwent cardiac surgery (10 ACB, 2 MVR, 3 ACB+MVR).

The mean age of patients at the time of implantation was 57.7 years. The mean postoperative stay until discharge was 38 days. 14 patients are still successfully undergoing LVAD-therapy. One patient died 6 days after surgery due to multi-organ failure caused by sepsis. None of the patients revealed wound infections of the thoracotomy and no thrombembolic complications were seen. 30 day survival rate was 93.3%. Finally, 14 of 15 patients were successfully discharged to rehabilitation.

Conclusions: This novel minimal-invasive surgical approach shows great considerable positive effects in reoperative cases. Minimal surgical trauma lowers the risk of bleeding events as well as wound infections and the positive outcome of our patients demonstrate obvious advantages in the treatment of cardiac failure by minimal-invasive LVAD implantation even in this group of high-risk patients.